Coronary Heart Disease

What is coronary heart disease?

Coronary heart disease is also called coronary artery disease. It is the number one killer of both men and women in the U.S.

Coronary heart disease is when the innermost layer of the coronary arteries becomes inflamed and narrowed. This is caused by a buildup of fatty deposits called plaque. These deposits may start in childhood and continue to thicken and enlarge throughout the life span. This thickening is called atherosclerosis. It can cut or block blood flow to the heart. A blood clot may also form on top of the plaque. Either of these can lead to a heart attack and even death.

The coronary arteries supply blood to the heart muscle. Like all other tissues in the body, the heart muscle needs oxygen-rich blood to work, and oxygen-depleted blood must be carried away. The coronary arteries run along the outside of the heart. They have small branches that supply blood to the heart muscle. The 2 main coronary arteries are the left main and right coronary arteries.

What causes coronary heart disease?

The most common cause of coronary heart disease is atherosclerosis. That’s when the inner lining of an artery becomes inflamed and builds up with plaque. It causes the artery to narrow or become blocked.

Who is at risk for coronary heart disease?

You may be at risk for coronary heart disease if you:

Smoke

Have high LDL cholesterol, high triglyceride levels, and low HDL cholesterol

Have high blood pressure

Are not physically active

Are obese or overweight

Eat a diet high in saturated fat

Have diabetes

Have a family history of heart disease

What are the symptoms of coronary heart disease?

The symptoms of coronary heart disease will depend on the severity of the disease. Some people have no symptoms. Others have episodes of mild chest pain (angina) when they are active. Some people have more severe chest pain even at rest.

If too little oxygenated blood reaches the heart, you may have angina. When the blood supply is completely cut off, the result is a heart attack. The heart muscle starts to die. Some people may have a heart attack and never notice the symptoms. This is called a "silent" heart attack.

These are the symptoms of coronary heart disease:

Heaviness, tightness, pressure, burning, or pain in the chest behind the breastbone

Pain spreading to the arms, shoulders, jaw, neck, or back

Shortness of breath

Weakness and severe tiredness (fatigue) especially during periods of activity

Nausea

Sweating

Chest pain that eases with rest

Chest pain that happens even at rest

Fainting (syncope) may be a symptom of a heart attack in elderly adults.

The symptoms of coronary heart disease may look like other health problems. Always see your healthcare provider for a diagnosis.

How is coronary heart disease diagnosed?

Your healthcare provider will ask about your health history and do a physical exam. You may also need these tests:

Electrocardiogram (ECG)

Stress test

This is also called an exercise echocardiogram or stress echocardiogram. This test takes ultrasound pictures of your heart while you rest and while you walk on a treadmill. It is done to see if your heart muscle is getting weak. It’s more sensitive and more specific than ECG by itself. A stress test may be used to find heart disease. Or it may be used to figure out safe levels of exercise after a heart attack or heart surgery.

Cardiac catheterization

The healthcare provider puts a wire into the coronary arteries of your heart. The provider then takes X-rays after injecting a contrast dye into an artery. This test can find narrowing, blockages, and other problems. It’s considered the best for finding artery disease. The provider may also be able to fix problems during the test.

Nuclear scanning (myocardial perfusion imaging)

The provider injects radioactive material into a vein. The material acts as a tracer for blood flow in the heart muscle. The provider takes images of the heart at rest with a special camera. Those images are compared with stress images. Stress on the heart can be brought on through exercise or with medicine. Damaged areas of the heart or areas of decreased blood flow don’t take up the tracer very well. This can help find areas of past heart attack or areas at risk for a heart attack.

CT scan

This is also called calcium scoring or CT angiography. This test uses X-rays from a CT scanner to help see the heart arteries and look for calcium. Calcium is often found in heart artery disease. How much calcium you have can help tell how severe your heart disease is. For CT angiography, contrast dye is injected through an IV to help see blood flow through the heart artery.

How is coronary heart disease treated?

Treatment for coronary heart disease may include:

Lifestyle changes

Living a heart-healthy lifestyle may help you slow or stop coronary heart disease. This may include quitting smoking, if you smoke. You may also have to start exercising, lose weight, and eat healthier foods such as lean meats, and fruits and vegetables. These steps can also help lower your cholesterol and blood pressure levels.

Medicines

Many medicines may be used to treat coronary heart disease. These include antiplatelets, such as aspirin. These lower the risk for blood clotting. You may also take medicines that lower your blood pressure, lower cholesterol levels, and treat diabetes.

Percutaneous coronary intervention (PCI)

This procedure uses catheters, balloons, and other tools to open the blocked blood vessel and improve heart artery blood flow. There are several types of PCI:

Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked part.

Coronary artery stent. A tiny mesh coil is expanded inside the blocked artery to open the blocked part. It is left in place to keep the artery open. This is done with balloon angioplasty

Atherectomy. The blocked part inside the artery is cut away by a tiny device on the end of a catheter.

Laser angioplasty. A laser is used to “vaporize” the blockage in the artery.

Coronary artery bypass graft

This treatment is also simply called bypass surgery. During this surgery, a bypass is created by grafting a pieces of arteries or veins above or below the blocked part of a coronary artery. It lets blood flow around the blockage. Veins are often taken from the leg. Arteries are taken from the chest or arm. Sometimes you may need several bypasses to fully restore blood flow to all parts of the heart.

What are possible complications of coronary heart disease?

Complications of coronary heart disease include:

Heart attack

Heart failure

Abnormal heart rhythms

Death

How can I help prevent coronary heart disease?

You can help prevent coronary heart disease by controlling your risk factors, such as:

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